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May 14, 2001Archives of Internal Medicine

A 1-SD change in SBP was associated with hazard ratios of 1.24 (95% CI 1.15-1.35) for myocardial infarction and 1.34 (95% CI 1.21-1.47) for stroke, making it a better predictor of cardiovascular events than DBP or pulse pressure.

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Why the study?

Does systolic blood pressure predict incident myocardial infarction, stroke, and total mortality better than diastolic or pulse pressure in adults 65 years and older?

Population

5,888 adults aged 65 years and older from 4 US centers, including 1,961 men and 2,941 women at risk for…

Design

Cohort

Follow-up

average 6.7 years

Authors

BPBruce M. PsatyCFCurt D. FurbergLKLewis H. Kuller

Discussion

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Overview

SBP may better inform CV risk prediction than DBP or PP in older adults; extends pulse pressure reports but leaves causality open pending trials.

Key Points

  • The aim is to assess the relationship between blood pressure levels and risks of myocardial infarction, stroke, and total mortality among older adults.
  • Population-based study involving 5888 adults aged 65 years and older from 4 US centers.
  • Baseline examinations conducted in 1989-1990, followed by monitoring cardiovascular events over an average of 6.7 years.
  • Statistical analysis adjusted for potential confounders to determine associations between blood pressure measures and cardiovascular outcomes.
  • 572 subjects experienced a coronary event, 385 suffered a stroke, and 896 died during follow-up.
  • Systolic blood pressure (SBP) was directly associated with a higher risk of both myocardial infarction (HR 1.24, 95% CI 1.15-1.35) and stroke (HR 1.34, 95% CI 1.21-1.47).
  • SBP was found to be a better predictor of cardiovascular events compared to diastolic blood pressure (DBP) and pulse pressure, indicating strong linear relationships.

Structured PICO

Does systolic blood pressure predict incident myocardial infarction, stroke, and total mortality better than diastolic or pulse pressure in adults 65 years and older?

P
Population
5,888 adults aged 65 years and older from 4 US centers (Cardiovascular Health Study), including 1,961 men and 2,941 women at risk for incident myocardial infarction or stroke.
I
Intervention
Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure levels (observational exposure)
O
Outcome
Incident myocardial infarction, stroke, and total mortalityhard clinical

In older adults, systolic blood pressure is a stronger single predictor of incident cardiovascular events and total mortality than diastolic blood pressure or pulse pressure.

Cite This Study

Psaty et al. (2001) studied this question.

synapsesocial.com/papers/6a194e13dec6c1694ed95c97https://doi.org/10.1001/archinte.161.9.1183
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